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PRINTED: 02/16/2022 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1)OMB NO 09380391PROVIDER/SUPPLIER/CIA
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The 0216 form, also known as Form 0216, is a tax form approved by the IRS for reporting certain transactions.
Individuals or entities who have engaged in reportable transactions are required to file Form 0216.
To fill out Form 0216, you will need to provide information about the reportable transactions, including dates, amounts, and other relevant details.
The purpose of Form 0216 is to report specific transactions to the IRS for tax purposes.
Information such as the nature of the transaction, dates, amounts, and any other relevant details must be reported on Form 0216.
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